Table 1.
Summary of military literature investigating VHA-guided resuscitation.
| Article | Participants | Type of Study and Setting | Conclusions |
|---|---|---|---|
| Plotkin et al., 2008 [15] | 44 military personnel with penetrating injuries | Retrospective Observational Setting: US Army Combat Support Hospital in Iraq |
TEG® as an adjunct to platelet counts and hematocrit was more predictive of blood transfusion than PT, aPTT, and INR together. Specifically, a reduced MA on TEG® within 24 h of admission correlated with more administered blood products. |
| Doran et al., 2010 [93] | 31 military personnel (19/31 received MT) |
Prospective Observational Setting: United Kingdom Military; Camp Bastion, Helmand province, Afghanistan |
ROTEM® is feasible in the military setting and has a greater sensitivity for coagulation abnormalities compared to PT and aPTT. |
| Prat et al., 2017 [94] | 219 military personnel (85 received ROTEM®-guided transfusion) |
Retrospective Observational Setting: US Craig Theater Hospital, Bagram Airfield in Afghanistan |
ROTEM® did not significantly improve mortality or MT protocol activation. However, the ROTEM®-guided group received significant increases in PLT and CRYO transfusions (4× and 2×, respectively). ROTEM® increased adherence to DCR protocol. |
| Cohen et al., 2019 [95] | 40 military casualties | Prospective Observational Setting: NATO Hospitals in Afghanistan |
ROTEM® detected hemorrhagic coagulopathy and need for MT with greater sensitivity than INR alone. ROTEM® should be included in MT protocols. |
| Lammers et al., 2020 [22] | 3320 military personnel (594 received VHA-guided initial resuscitation) | Retrospective Observational Setting: US-led NATO Role III Multinational Medical Unit |
VHA-guided resuscitation was independently associated with a decreased mortality (OR, 0.63; p = 0.001) and a 57% reduction in overall mortality (7.3% vs. 13.1%, p = 0.001). |
aPTT, activated partial thromboplastin time; CRYO, cryoprecipitate; DCR, damage control resuscitation; INR, international normalized ratio; MA, maximum amplitude (TEG® Parameter); MT, massive transfusion; PLT, platelet; PT, prothrombin time; ROTEM®, rotational thromboelastometry; TEG®, thromboelastography; VHA, viscoelastic hemostatic assay.